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Community Market Analyses Grantees
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Goal: To improve state capacity to reduce health inequities by providing them with data on social determinants of health and consumption patterns that influence health at the community level.

Below are the states DHPE provides marketing data and technology to through a CDC co-operative agreement. List of the projects they worked on utilizing market research data and technology are provided in the links below.

States Funded

Funding Period

Alabama

Dec 2011- Sep 2013

Delaware

Oct 2013- Sep 2014

District of Columbia

Dec 2011- Sep 2014

Great Lakes Inter-Tribal Epidemiology Center (GLITEC)

Dec 2011- Sep 2014

Illinois

Sep 2011- Sep 2014

Maryland

Oct 2012- Sep 2014

Michigan

Sep 2011- Sep 2014

Minnesota

Dec 2011- Sep 2013

Mississippi

Sep 2011- Sep 2014

North Carolina

Dec 2011- Sep 2014

New Jersey

Oct 2013- Sep 2014

Oregon

Sep 2011- Sep 2012

Pennsylvania

Sep 2011- Sep 2014

South Carolina

Sep 2011- Sep 2014

Utah

Oct 2012- Sep 2014

Washington

Sep 2011- Sep 2012

States Receiving only Technical Assistance

Ohio

Sep 2011- Sep 2014

Louisiana

Sep 2011- Sep 2013


Alabama

Media Usage among Rural and Under-served Populations

Developed a partnership with the Office of Minority Health to help target new interventions. The market research data has identified media usage by different population centers throughout the state as well as rural areas that have traditionally been over looked.

Disaster Planning

Developed a Disaster Data Plan outlining data sources available that can monitor events and distribute information to target populations. As part of the plan development, market research data and technology identified the distribution of vulnerable and at-risk populations. Demographic, and media consumption and usage profiles were developed for each county and public health area as well as for specific minority and at-risk populations.

Targeting Health Inequities

Utilized market research data and technology to help target efforts to reduce health inequities as outlined in Alabama’s Plan to Reduce Health Disparities.

Excessive Use of Pain Medication

Worked with the Prescription Drug Monitoring Program and the State Pharmacy Division to identify populations at-risk for excessive use of pain medications based on purchasing trends and locations.

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Delaware

Targeting Health Inequities

Incorporating market research data in a comprehensive health equity report targeted for completion by the end of 2014. This baseline report will provide the state, as well as communities, with information to use for planning purposes and allow them to measure progress over time.

Community Assessments

Characterizing "neighborhoods” (geographic boundaries yet to be determined), using multiple variables – e.g., income, education, age, food accessibility – as one step in identifying places to focus more intensive public health efforts.

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District of Columbia

Food Environment and Obesity

Evaluated obesity in the District of Columbia (DC). Analysis showed high obesity rates and food deserts co-exist in the same wards and census tracts. Analysis included examining the spatial interaction between food deserts and obesity as well as access to healthy foods and the association of poverty with these factors. Fast food expenditures, expenditures on fresh fruits and vegetables, and proximity of certain neighborhoods to recreational areas and parks were part of the analysis.

Infant Mortality

Compared spatial distribution patterns of infant mortality and life stage groups. The analysis determined which life stage groups were likely to experience the highest number of infant deaths. These life stage groups were further analyzed to determine how to best target interventions and prenatal care messages.

Alcohol Consumption

Examined alcohol expenditures by census tract. The results were incorporated into the DC Alcohol Report.

Asthma and Its Risk Factors

Determined which areas of the District have the highest rate of asthma prevalence, asthma hospital discharges, obesity, and tobacco use, then conducted an analysis to look at the lifestyle and social behaviors of households living in these areas in an effort to target interventions toward areas of greatest need. Results were included in the Spatial Distribution Patterns for Asthma, Crude Deaths, Discharges, Discharge Costs and Selected Variables, 2008 – 2010 report.

Low Birth Weight and Infant Mortality

Compared the spatial distribution patterns of high and low infant birth weight, infant mortality, and life stage group as well as examined the built environment and socio-economic characteristics that may contribute to higher mortality rates. The results helped target specific locations in the District by the Perinatal and Infant Health Bureau of the DC department of health (DOH) Community Health Administration.

Ten Leading Causes of Deaths

Conducted a spatial analysis of the Ten Leading Causes of Deaths, 2008. Maps were used to characterize the populations in places with high mortality. These maps are part of the annual report on the leading causes of mortality in DC. DOH programs, policy makers, public health practitioners and others interested in the health and wellness of District residents use these maps for planning and targeting interventions.

Lung Cancer

The Center for Policy Planning & Evaluation (CPPE) characterized the spatial patterns of indoor radon, lung cancer hospital discharges and prevalence, and life stage groups. CPPE seeks to determine the level of uncertainties associated with GIS maps designed for evidence-based decision making. The Department of Health’s Cancer Registry will use the results to collaborate on programs aimed at mitigating indoor radon hazards, and reducing lung cancer incidence and hospitalization. Results from the radon and lung cancer study can help cost-effectively target radon mitigation and education materials using the Nielsen dominant target characteristics.

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Great Lakes Inter-Tribal Epidemiology Center (GLITEC)

Alcohol Prevention

Project 1: Examined alcohol-related crash data from the Minnesota Department of Transportation in conjunction with alcohol retail environment data from Nielsen. Non-metropolitan Contract Health Service Delivery Areas (CHSDA) and non-CHSDAs were compared. In 2011, there were twice as many alcohol-serving establishments ("drinking places”) per capita in CHSDAs compared to non-CHSDAs. Overall, there were 57% more places to buy alcohol per capita in CHSDAs than non-CHSDAs. Crashes in CHSDA counties were 40% more likely to be alcohol-related compared to non-CHSDAs, and the alcohol-related crashes in CHSDAs were over twice as likely to result in a fatality. GLITEC presented results from this analysis at the 2012 APHA conference and is working with its partners to identify potential partners that can help strategize an approach to addressing this issue.

Project 2: Examined the ratio of grocery stores to liquor stores within the CHSDA, counties that include or adjoin a reservation, in Minnesota. CHSDAs were compared to non-CHSDAs. Results showed that the CHSDAs had a lower ratio of grocery stores to liquor stores compared to non-CHSDAs.

Identifying Populations Known to Have Health Disparities

Project 1: Provided data regarding urgent care centers, pharmacies and dentist to assist the Tribal Health Director in building a case for expanded services based on existing services and the surrounding population. Maps were created identifying locations of these services and segmentation analysis was performed to better understand the population being served. As the federal government does not fully fund health care services for tribes, providing health care services to non-tribal populations can help supplement and sustain services for the tribal population throughout the year.

Project 2: Provided the Minnesota Department of Health with a list of high schools that have a high number/percent of American Indian/Alaska Native students to include in a survey of selected schools’ nutrition and physical activity policies.

Nutrition and Physical Activity

Examined the presence of fast food restaurants and health outcomes in non-metropolitan counties on or near reservations CHSDAs compared to counties NOT on or near reservations in Minnesota. The number of limited-service restaurants and snack bars per capita in each geographical area was calculated. Multiple segmentation and consumption analyses were conducted. There were no significant differences between CHSDAs and non-CHSDAs consumption behaviors.

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Illinois

Disabilities

Developed a report on the types of disabilities by county and zip code. The program is now working on overlaying health data for people with disabilities to develop a more complete picture of where people with disabilities are located and the types of resources they have available.

Food Deserts

Worked with the Springfield Urban League and the Illinois Stewardship Alliance to develop food desert maps and conduct food gap analysis to assist these organizations in applying for a competitive community food grant. The analysis helped the organization justify targeting its planned interventions so that they could focus on one specific area of Springfield.

Nutrition and Physical Activity/ School Health

Developed community profiles for each school implementing the Coordinated Approach to Child Health (CATCH) Program. These profiles promoted options for increasing the proportion of individuals who have access to a grocery store. They also promoted providing access to public and private school’s physical activity spaces and facilities to communities outside of normal school hours (Healthy People 2020 PA-10 objective).

Tobacco Prevention

Project 1: Mapped the location of all parks in Illinois in conjunction with Nielsen PRIZM data, Behavioral Risk Factors Surveillance System (BRFSS) data and quitline data to identify parks in areas with high smoker rates and low quitline use.

Project 2: Used market research data to make decisions on how and where to spend grant money to promote the Illinois Tobacco Quitline. An analysis of heavy tobacco users, occasional tobacco users, and smokeless tobacco users was generated to identify high-risk populations and highlight their behaviors and media preferences. The tobacco reports have helped grantees focus program and project efforts. One grantee expressed that the report helped them to identify who to target for a survey on smoking use in disparate populations.

Project 3: Examined the proximity of tobacco wholesalers to schools as well as the amount of money spent on tobacco products by zip code. This information is being use to inform youth tobacco prevention efforts.

Project 4:Developed a report highlighting how Illinois Tobacco-Free Communities grantees use market research data (http://www.idph.state.il.us/pdf/Tobacco_Volume_2_Issue_9_August.pdf).

Depression
The depression medication community profile targeted areas with high use of depression medications and will concentrate on media usage/media preference data and demographic data. The purpose is to lower the burden of suicide by using these reports and in conjunction with other community level suicide data to develop policy recommendations.

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Louisiana

Tobacco

Developed reports that estimated where heavy smokers lived by parish. The Louisiana Tobacco Control Program used this information to determine where to promote tobacco cessation efforts.

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Maryland

Tobacco

Project 1: Examined use of smoking cessation aids within Maryland by county to assess where to enhance outreach efforts.

Project 2: Examined access to tobacco (tobacco sales) near 24 multi-unit housing complexes in 13 rural Maryland counties.

Healthy Stores

Using market research data to calculate the CDC modified retail food environment index (mRFEI)1. The mRFEI in combination with data from the BRFSS and data the state has collected on food sales in a sample of small rural stores will inform interventions to improve the food environment.

References

1. Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion; Division of Nutrition, Physical Activity, and Obesity. Census Tract Level State Maps of the Modified Retail Food Environment Index (mRFEI), 2011, Atlanta, GA. Available at ftp://ftp.cdc.gov/pub/Publications/dnpao/census-tract-level-state-maps-mrfei_TAG508.pdf.

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Michigan

Alcohol

Examined adult alcohol consumption in Michigan as very little is known other than self-reported behaviors in population surveys; of particular interest are brand-specific alcohol preferences. Market research data and technology were used to estimate brand-specific alcohol consumption, map alcohol retail locations in Wayne County, and describe demographic and purchasing information about families living within 1,000 feet of an alcohol retailer. Results were well-received by federal partners, the Center for Alcohol Marketing and Youth (CAMY), and at the 2012 Council of State and Territorial Epidemiology Conference. The project is informing future programming and community action in Detroit and parts of Wayne County.

Food Deserts/Food Environment

Project 1: Utilized market research data and technology to produce maps for the 2011 Obesity Summit that looked at food deserts. These maps introduced the concept of a "food desert” and demonstrate that food deserts are not limited to urban areas and can occur anywhere, including rural or more affluent parts of the state. This information was utilized to develop strategies focusing on access to healthy eating options that were included in the Governor’s Health and Wellness Plan, which describes Michigan’s approach to obesity and wellness over the next five years. This plan resulted in new state funding for fiscal year 2013 that provided grants to six local community coalitions. A major focus of these grants is to increase availability of healthy foods and access to physical activity opportunities in communities.

Project 2: Created community profiles of Muskegon and Oceana counties to highlight food and health care access, as well as the distribution of racial/ethnic minority populations.

Project 3: Mapped CDC’s mRFEI1 for a clearer view of the spatial location and distribution of healthier retail food outlets as compared to less than healthy retail. CDC guidance for the 1305 grant defines "underserved” census tracts as those with a 0 mRFEI score, meaning they do not have a full service grocery store, supermarket or commercial fruit market in them. Disparities among retail food environments, especially when assessments take into consideration access to less than healthy food in addition to healthy foods, represent an important health equity issue and seek to address the Healthy People 2020 objectives of improving Nutrition and Weight Status. Market research data allows the health department to provide specific recommendations on environmental, health promotion and educational interventions that can improve the consumption of nutrient dense foods and limit the consumption of saturated and trans fats, cholesterol, added sugars, and sodium among specific target populations in specific geographic locations.

Project 4: Continuing to describe the food environment and potential gaps. Gaps are identified by :

  • Examining areas where grocery demand exceeds supply
  • Identifying areas as that have low-access to healthy foods in proportion to access to less than healthy foods using mRFEI Scores
  • Comparing state and local public health data with neighborhood, market segment, and retail characteristics to help target areas of need

Identifying Populations Known to Have Health Disparities

Created maps to demonstrate inequities based on race and place in Benton Harbor and St. Joseph, Michigan.

Nutrition and Physical Activity

Project 1: Examined access to physical activity opportunities in two Grand Rapids neighborhoods.

Project 2: Used market research data to strategize how to reach Meijer [ a large grocery store chain – similar to Supper Wal-Mart] shoppers to promote NuVal, a nutritional value rating system for all products sold at Meijer.

Media Outlets Used by Tribal Communities

Identified popular media outlets used by tribal communities in response to a technical assistance request by grantees interested in refining their health communication efforts.

Identify Resource Gaps

Helped identify resource gaps in Muskegon. The Muskegon Community Health

Project (MCHP) has a 3-year grant from Michigan Department of Community Health’s Health Disparities

Reduction and Minority Health Section to address health inequities in Muskegon and Oceana Counties. Maps and tables provided to MCHP identified community assets and hazards and located areas of greatest need for healthy resources.

Women, Infants, and Children (WIC)

Overlaid WIC clinics with WIC vendors as they relate to other potentially influential neighborhood characteristics. The information described the access and availability of healthier food as well as gaps and is being used to develop target messages, explore food purchasing barriers and identify strategies for areas where access is needed.

References

1. Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion; Division of Nutrition, Physical Activity, and Obesity. Census Tract Level State Maps of the Modified Retail Food Environment Index (mRFEI), 2011, Atlanta, GA. Available at ftp://ftp.cdc.gov/pub/Publications/dnpao/census-tract-level-state-maps-mrfei_TAG508.pdf.

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Minnesota

Food Environment

Used business location information to conduct a statewide analysis of access to healthy and unhealthy foods around a sample of more than 80 high schools across the state. These data were used to create the mRFEI1 value for the area around high schools. This information in conjunct with data on physical activity and weight status of students are being used to inform school wellness policies.

Oral Health

Worked with the Oral Health Section within the Minnesota Department of Health’s (MDH) Center for Health Promotion on a competitive renewal application to Health Resources and Services Administration. As part of the application, Minnesota included a project to identify and assess Dental Service Access Deserts in Minnesota through geo-mapping of the dental service areas.

At-Risk for Low Health Literacy

Utilized market research data and technology to create a Minnesota map displaying areas at-risk for low health literacy. MDH’s Center for Health Promotion is starting an initiative to address health literacy in the state. Based on a literature review the following groups typically have lower health literacy: older adults, racial and ethnic minorities, less than a high school degree or GED, non-native speakers of English, and individuals with compromised health status.

References

1. Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion; Division of Nutrition, Physical Activity, and Obesity. Census Tract Level State Maps of the Modified Retail Food Environment Index (mRFEI), 2011, Atlanta, GA. Available at ftp://ftp.cdc.gov/pub/Publications/dnpao/census-tract-level-state-maps-mrfei_TAG508.pdf.

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Mississippi

Food Deserts/ Food Environments

Project 1: Assessed food access inequalities and health disparities in Rural Mississippi.

Project 2: Assessed the best methods for defining and identifying food deserts in the Delta region, which is rural and does not have many food venues. Also examined transportation as part of the food desert analysis. An abstract outlining this work was submitted to the American Public Health Association (APHA).

Project 3: Targeted healthy eating risk factor by determining where food deserts are located in the 18-county Delta region. The entire region is a food desert according to both the US Department of Agriculture and there was a food gap in these areas. Food gap is defined as having more demand for food than supply and where 20% or more of the population is living below poverty.

Project 4: Worked with the Mississippi Delta Health Collaborative on policy environmental and systems changes. As part of this effort, the Mississippi State Department of Health (MSDH) developed maps of various food resources (e.g., restaurants, convenience stores, grocery stores). These maps were disseminated at forums/events to engage and educate the community. They were also used to identify areas of opportunity to place healthier alternatives such as farmers markets.

Identifying Populations Known to Have Health Disparities

Developed maps identifying areas with high poverty and low educational attainment.

Pregnancy Risk Assessment Monitoring Survey

Developed consumer profiles of potential survey participants in hard to reach minority populations for the Pregnancy Risk Assessment Monitoring Survey (PRAMS) program. These profiles were used to identify areas to target for participation in the survey as well as identify incentives to participates would like.

Environmental Scan Assessment

Conducted an Environmental Scan Assessment in Public Health Districts VI and VII in an effort to describe and address the burden of chronic disease in these districts. The environment scan will help MSDH understand the environment where people live, work, and play. They are planning on mapping food retail outlets, such as grocery stores, convenience stores, and fast food restaurants. Recreational facilities, health services, and mental health services will also be mapped. These maps will aid in determining areas of opportunities for interventions that will address unhealthy diet, physical inactivity, and other risk factors for chronic disease in the region.

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North Carolina

Tobacco

Project 1: Used data from the quitline in conjunction with market research data on heavy smoker data to identify target areas for increasing media outreach.

Project 2: Created maps on cigarette spending for the Tobacco Prevention & Control Branch in order to help target cessation efforts.

Physical Activity

Worked with the Community Transformation Project to identify communities that would benefit from having access to school gym facilities before and after school hours as a safe place to participate in physical activity.

Food Environment

Project 1: Identified retailers with healthier food options as well as where to expand food outlets by adding farmers markets. This information was incorporated into the Town of Davidson’s Food Access Plan

Project 2: Created maps of convenience store locations in each region for the "Corner Store Pilot Initiative” project. Included in the map were populations negatively affected by health inequalities, based on social determinants of health. This project targets existing stores and works with convenience store owners in low-income communities to find ways to offer healthier, more affordable foods and beverages. As part of this initiative, a community profile was created around a store location in Pitt County.

Project 3: Helped develop marketing strategies for two new farmers’ market sites in Guilford County to encourage use among target populations.

Nutrition and Physical Activity

Assisted in the development of a Bicycle and Pedestrian plan in conjunction with North Carolina Department of Transportation, Department of Environment and Natural Resources, and the Department of Commerce for Building Healthy Communities. Statewide maps by county show the population that bike or walk to work and informed the Bicycle and Pedestrian plan.

Population Estimates

Project 1: Utilized Nielsen 2011 and 2012 demographic data to develop synthetic county estimates for the North Carolina Behavioral Risk Factor Surveillance System (BRFSS). Discussions have taken place to develop ways these data may help increase response rates and provide data on cell phone usage.

Project 2: Utilized market research data and technology to produce demographic reports that helped create the ten regions for the Community Transformation Project. North Carolina Department of Public Health leadership found these data to be valuable in their ongoing efforts to promote healthy North Carolinians, Community Transformation Projects, The Corner Store Initiative, and locating new Farmer’s Markets.

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Oregon

Nutrition and Physical Activity

Mapped addresses of Oregon Farmers Markets in the Portland Metropolitan area to identify gaps in access to fresh fruits and vegetables. The Portland Farmers Market Board can use the maps to determine locations for future farmers market locations in the Portland Metropolitan area.

Nutrition and Physical Activity/ School Health

Accessed addresses of schools within the Portland Public School System and locations of convenience stores and fast food establishments in the Portland Metro area. These data were used to generate a map that displays the food environment around Portland Public Schools, which has implications for childhood obesity.

Tobacco

Project 1: Generated maps of tobacco consumption (average weekly expenditure on cigarettes per household) for the top 2 counties with the highest cigarette smoking prevalence according to 2006-2009 BRFSS. These maps assisted county grantees in pinpointing census tracts with the highest smoking prevalence for targeted smoking cessation interventions.

Project 2: Generated segmentation profiles for the zip codes of current cigarette smokers identified through Oregon’s BRFSS, as well as zip codes of callers to Oregon’s tobacco Quit Line. Compared the segmentation profiles of QuitLine callers and BRFSS current cigarette smokers to determine which segments are not being effectively targeted through Oregon’s QuitLine.

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Pennsylvania

Cancer Control

Exploring ways market research data can be utilized to improve cancer screening outreach/marketing to under-served populations.

Emergency Preparedness/Response

Worked with Pennsylvania Department of Health’s (PADOH) Office of Public Health Preparedness during the aftermath of Pennsylvania flooding in September 2011 to identify counties/zip codes with largest Hispanic/Latino populations. The Governor opened Disaster Recovery Centers (DRCs) in each county that was affected by flooding, and the Office of Public Health Preparedness provided Spanish-language preparedness and recovery information at each DRC. Marketing data were used to estimate the distribution of Spanish-language flyers/information based on Hispanic population in affected counties.

Access to Health Care Facilities

Partnered with the Philadelphia Department of Public Health to provide physician (by specialty) and commercial pharmacy locations across the City of Philadelphia. City health officials will use these data to measure medical and pharmacy gaps across the city.

Identifying Populations Known to Have Health Disparities

Drafted county community lifestyle profiles to complement PADOH’s Bureau of Health Statistics and Research County Health Profiles. A profile was developed for each county and large city for program administrators and PADOH grantees to use while designing health programs for the public.

Tobacco

Explored the use of market research smoking-related profiles for a project aimed at reducing the lung cancer risk of those populations exposed to cigarette smoke and high radon levels.

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South Carolina

Tobacco

Created maps on cigarette spending for the Tobacco Prevention & Control Branch in order to help target cessation efforts.

Food Environment

Project 1: Developed a map displaying food desert, population density, and the location of farmers’ markets throughout the state. The addition of farmers’ markets illustrates another access point to fruits and vegetables beyond traditional supermarkets and grocery stores. This map illustrates that food deserts not only exist in less densely populated counties, but also in some of the more populated counties. Analysis reveals approximately 25% of the South Carolina population lives in a food desert.

Project 2: Identified potential farmers market sites based in Fairfield County.

Hypertension

Worked with their media and communications coordinator in the Heart Disease and Stroke Prevention Division to geographically identify target areas a for hypertension awareness radio campaign in South Carolina.

Identifying Populations Known to Have HealthDisparities

South Carolina Department of Health and Environmental Control identified communities at high-risk of obesity using BRFSS historical data. SC DHEC plans on using market research data to gain better insights into those communities.

Immunizations

Collaborating with the Office of Minority Health (OMH) to explore immunization coverage for certain populations within South Carolina. OMH is focusing on four regions that have low immunization coverage. Market research data and technology helped target those population pockets.

Nutrition and Physical Activity

Collaborated with the Office of Nutrition, Physical Activity, and Obesity on sugar-sweetened beverage consumption in SC. The DNPAO established partnership and coalitions in 20 communities and are using market research data to target interventions.

Tobacco

Project 1: Examined South Carolina’s expenditure on cigarette products by county to help target a cessation campaign.

Project 2: Conducted a media campaign promoting their Quitline in four counties: Charleston, Darlington, Greenville, and Richland. Market research data were used to target heavy smokers. Radio and television preferences of heavy smokers were identified. The "New Year Resolution” media campaign began on December 15, 2013. Press releases promoting SC’s Quitline were distributed to local newspapers in the targeted counties.

Employee Wellness

Businesses with 50 or more employees were identified. These businesses are being surveyed to determine if they have employee wellness plans and the type of plan they have.

Cancer

Utilized demographics and media data to target areas that have high-risk factors associated with cancer. Examined cancer incidence, mortality, BRFSS data, and high tobacco use, high fast food consumption, and low tobacco cessation use to identify high-risk areas then generated top radio and television use for these high-risk areas.

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Utah

Obesity

Compared areas with high levels of obesity (identified with BRFSS) to those with low obesity levels. These areas were compared with respect to enhanced demographics, purchasing habits (fruit and vegetable, gym passes, etc.), as well as many social determinants of health (housing, percent of income spent on housing, health care access, poverty, etc.).

Food Environment

Recreated CDC’s mRFEI1 for a clearer view of the spatial location and distribution of healthier retail food outlets as compared to less than healthy retail. CDC guidance for the 1305 grant, defines "under-served” census tracts as those with a 0 mRFEI score, meaning they do not have a full service grocery store, supermarket or commercial fruit market in them. Utah augmented the index by including Farmer’s Markets as a health retail food outlet.

Prenatal Care

Created three aggregate geometries of poor birth outcomes from all the Utah small areas that had either infant mortality rates over 7.5/1,000 in 2008-2012, or preterm birth rates over 10.5% in 2012, or both. These aggregated areas are used to determine what factors may contribute to disparities in access to care.

References

1. Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion; Division of Nutrition, Physical Activity, and Obesity. Census Tract Level State Maps of the Modified Retail Food Environment Index (mRFEI), 2011, Atlanta, GA. Available at ftp://ftp.cdc.gov/pub/Publications/dnpao/census-tract-level-state-maps-mrfei_TAG508.pdf.

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Washington

Nutrition and Physical Activity

Worked with the Supplemental Nutrition Assistance Program (food stamps) to identify gaps in service delivery.

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